Provider Demographics
NPI:1104966563
Name:SANDY, JUDY M (LCSW ACSW LCAC)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:M
Last Name:SANDY
Suffix:
Gender:F
Credentials:LCSW ACSW LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N 4TH ST STE 407
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1308
Mailing Address - Country:US
Mailing Address - Phone:765-420-1643
Mailing Address - Fax:765-746-3664
Practice Address - Street 1:133 N 4TH ST STE 407
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1308
Practice Address - Country:US
Practice Address - Phone:765-420-1643
Practice Address - Fax:765-746-3664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000471A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical